Research Brief: Non-classic celiac symptoms delay diagnosis

Research from three U.S. hospitals reveals patients with non-classic celiac symptoms face a much longer delay in diagnosis. In a cohort of 101 adult patients, 52 who initially saw a doctor with gastrointestinal complaints were typically diagnosed in 2.3 months. The median diagnosis time for people with non-gastrointestinal symptoms was 3.5 years. These patients showed signs including fatigue, anemia, thyroid, liver or bone density abnormalities, or dermatitis herpetiformis, a form of celiac causing skin blisters.

The study included only patients with biopsy-proven celiac. The authors say their findings show doctors should evaluate patients for celiac if they have unexplained anemia, thyroid disease or abnormal bone density.

Thyroid disease

Autoimmune thyroid disease commonly occurs alongside celiac. In this group of patients, a remarkable 43.2 percent of those lacking gastrointestinal symptoms had thyroid abnormalities compared to 15.5 percent of those with gastrointestinal symptoms. Overall one-third of patients had abnormal thyroid hormone levels, much higher than reported in any other study.

Anemia and bone density

A majority of the non-gastrointestinal group had anemia and abnormal bone scans: 69.4 percent and 68 percent, respectively. These problems were less prevalent among those with gastrointestinal symptoms: 11.5 percent and 41 percent, respectively. Few patients had dermatitis herpetiformis or liver abnormalities.

The authors note 11 percent of this study group were Hispanic and 3 percent were African American. This appears higher than expected as celiac is considered rare among U.S. ethnic minorities.

The authors say they are unaware of any previous study to compare gastrointestinal and other symptoms in biopsy-proven celiac. This fresh perspective comes from Howard College of Medicine in Washington D.C., Loyola Medical Center in Maywood, Illinois, and Medical University of South Carolina, Charleston. These are outside the group of several celiac clinics that conduct the most U.S. research. The study did not account for various other non-gastrointestinal conditions. These include peripheral neuropathy and mouth ulcers that may be associated with celiac.

Paez MA, Gramelspacher AM, Sinacore J, Winterfield L and Venu M, “Delay in diagnosis of celiac disease in patients without gastrointestinal complaints,” The American Journal of Medicine, November 2017, 130;11:1318-1323, doi.org/10.1016/j.amjmed.2017.05.027.

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